Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe

Autores da FMUP

• Nuno Miguel De Sousa Lunet

  Autor

Participantes de fora da FMUP

• Mensah, Keitly
• Mosquera, Isabel
• Tisler, Anna
• Uuskula, Anneli
• Firmino-Machado, Joao
• Nicula, Florian
• Taut, Diana
• Baban, Adriana
• Basu, Partha
• CBIG SCREEN Consortium

Unidades de investigação

• Ciências da Saúde Pública e Forenses, e Educação Médica

Abstract

BackgroundCervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings.MethodsOur research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants' interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context.ResultsConducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions.ConclusionsOur study's novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

Keywords

• Cervical cancer; Screening; Capacity assessment; Implementation; Contextual analysis; Europe; Romania; Estonia; Portugal; Vulnerable women; Facility visit; Interview; HPV-based screening